虚血性心疾患を合併した高齢者ASDの1手術例

A case of successful surgery for atrial septal defect combined with coronary artery bypass grafting

　心房中隔欠損症と冠動脈疾患を合併した症例に対し欠損孔閉鎖術と冠血行再建術を同時施行したので報告する。本症例は術前，右室機能障害に加え虚血による左室機能低下もあったが，術後は両心機能ともに改善し自覚症状の消失もみられた。

A 66-year-old man, who had atrial septal defect (ASD) associated with severe coronary artery disease, underwent closure of ASD and concomitant coronary artery bypass grafting (LIMA-LAD & SVG-RCA). Response to surgery was excellent, with improve-ment of cardiac function and returning to NYHA functional class I, while, preoperatively, the patient had been limited due to symptoms related both to large left to right shunt flows (Qp/Qs 3. 04) and to left ventricular dysfunction because of severe myo-cardial ischemia as well as previous inferior myo-cardial infarction.

SAD is the most common form of congenital heart disease requiring surgery in adults, accordingly it should be remembered that some of the elderly pa-tients with ASD might have obvious or occult coronary artery disease at the time of diagnosis and operative intervention.